The current Director of the Africa CDC is a vote away from leading PEPFAR. He unveils his vision for the US-led global HIV/AIDS response and future wishes for the Africa CDC.

Dr John Nkengasong, Director of the Africa Centres for Disease Control and Prevention (Africa CDC) is on track to lead the United States President’s Emergency Plan for AIDS Relief (PEPFAR) as the Ambassador at Large and coordinator of US activities to combat HIV/AIDS globally. 

Although Nkengasong is yet to officially announce his exit plans for Africa CDC, he has already appeared before the United States Senate Committee on Foreign Relations to answer questions from senators ahead of a vote to confirm his nomination by President Joe Biden. He would fill a position that has been left vacant for two years – ever since Deborah Birx stepped away from the post to join President Donald Trump’s COVID-19 response team.

The road ahead for Africa CDC

If finally confirmed to lead PEPFAR, Nkengasong’s departure from the Africa CDC is expected to raise concerns about the future of the African Center – which rose to prominence under his guidance steering a steady course in the storms of the COVID pandemic – and only recently gained the status of an independent agency. 

Asked by Health Policy Watch about his pending PEPFAR appointment in a Thursday briefing, Nkengasong refrained from speculating on how his departure might affect the agency or who would replace him at its helm.  

But he said that the next agenda for Africa CDC is to leverage the gains of its COVID-19 response in strengthening its healthcare systems across the African Union’s 55 member states, and to be better positioned to fight future pandemics.

“The continent has been extremely innovative in developing platforms that are continuously being used to fight this COVID pandemic but we need to focus our energy on developing them to fight other diseases,” he said.

He noted that initiatives such as the African Medical Supplies Platform that was set up to fight COVID can now be expanded to fight other diseases in terms of commodities and supply chain management. 

“So I’m really pleased to see the initiatives that have come out of this continent [and] my greatest wish would be that these initiatives be sustained and developed further so that they can be used in managing other diseases, including future pandemics,” he told Health Policy Watch.

Testimony before the US Senate

PEPFAR has a long history of involvement in Africa, dating back to its inception in 2003. Africa HIV/AIDS programs have largely been the beneficiaries of PEPFAR investments exceeding over $100 billion. The plan claims it has saved 21 million lives, prevented millions of HIV infections, and is supporting several countries to achieve HIV epidemic control – all while significantly strengthening global health security.

In Nkengasong’s opening testimony before the US Senate on Tuesday, March 15, 2022, the Cameroonian virologist said he will draw upon his three decades of experience with research and programmes public health and HIV to advance PEPFAR’s mission, assure its continued success, collaborate with partner governments and communities, and sustain the strong partnership it enjoys with the US Congress.

“If confirmed, I would be stepping into this role at a critical moment when the world is confronted with dual global pandemics.  We have seen how COVID-19 has affected some progress in our HIV efforts with devastating results. But we have also witnessed how the health systems and institutions built and strengthened by PEPFAR’s investments have been central to the COVID-19 response,” he told the senators.

As Director of the Africa CDC, Nkengasong said he has seen how PEPFAR’s investments in health systems over the past 19 years have strengthened—and in some cases, established—the fundamental health infrastructure, laboratories, surveillance systems, and human resources for health in the countries where it helps serve.

While noting that previous efforts around HIV prevention, treatment and control were premised upon building ‘vertical’ systems as semi-independent entities, almost from the ground up, the goal has now shifted. PEPFAR’s future efforts must now ensure that these HIV services and systems are well integrated into national health systems, sustainably financed, and resilient to prevent and respond to HIV/AIDS in the future, as well as other diseases.  

“For this to happen, it is my belief that we need to capitalize on the capacity and experience of those in the countries where we work, coming to the table with a deep respect for their perspectives and needs, taking account of their insights, their knowledge of local contexts, and their reservoirs of expertise.  For such systems to be sustainable and keep infectious disease in check, we must act collectively to support the capabilities of local leaders and regional institutions and work in respectful partnership and accountability with them,” he said.

A dual US-Cameroonian citizen  

A native of Cameroon, Nkengasong earned his undergraduate degree at the University of Yaounde, and later studied at graduate level at the Institute of Tropical Medicine Antwerp, at the encouragement of the famed Belgian-British microbiologist, Peter Piot. After completing his second master’s degree in medical sciences in Brussels, he joined the World Health Organization in 1993.

In the mid-1990s, he moved to the United States where he spent a stint at the University of California at Berkeley, as a Fogarty International Center trainee, after joining the US Centers for Disease Control and Prevention. He then took over the leadership of the US CDC’s virology lab in Abijdjan, Ivory Coast. 

Nkengasong subsequently returned to the States and rose to the role of acting deputy principal director for the CDC’s Center for Global Health in Atlanta, Georgia – the state where he also holds US citizenship. 

In early 2017, he was appointed director of the newly-created African CDC. 

“In 2014, when Ebola hit West Africa, the heads of state met again and asked the African Union commission to accelerate the establishment of the Africa CDC,” Nkengasong recalled in a 2017 interview, published by the Fogarty International Center. “For all the human and economic destruction wrought by Ebola, it ended up being the catalyst that pushed African leaders to rapidly advance the concept that they nurtured in 2013 to bolster the continent’s public health response, and Africa’s continent-wide public health agency was launched in January 2017.”

Hopefully, the COVID-19 pandemic can have a similar effect on promoting Africa CDC’s continued development – regardless of who remains at its helm.